We recently derived empirically based quantitative criteria for insomnia (Lichstein et al., 2003), providing a reasoned alternative to the extant typical epidemiological practice of determining insomnia presence
solely by asking individuals, do you have insomnia? We combined two
approaches to establish diagnostic criteria. First, we reviewed two decades of psychology clinical trials for insomnia to determine modal practice with regard to frequency, severity, and duration criteria for
insomnia. This procedure identified widely accepted frequency and duration criteria, but failed to resolve ambiguity in selecting severity criteria. Second, we applied sensitivity-specificity analyses to four common
severity criteria to identify the most valid criterion. We concluded that
severity of sleep onset latency (SOL) or wake time after sleep onset
(WASO) of (a) ≥31 min (b) occurring ≥3 nights a week (c) for ≥6
months are the most defensible quantitative criteria for insomnia.

Poor sleep is critical to diagnosing insomnia, but it is not sufficient. We
also considered evidence of daytime impairment requisite to conferring
this diagnosis. This standard derives from the ICSD, which requires a re-

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